Provider Demographics
NPI:1760448765
Name:RIM, ALEXANDER JAEWOOK (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:JAEWOOK
Last Name:RIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 NW 64TH TERRACE
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-6777
Mailing Address - Fax:352-331-8899
Practice Address - Street 1:1121 NW 64TH TERRACE
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-6777
Practice Address - Fax:352-331-8899
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91673208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52062OtherBCBS
FL271281400Medicaid
FL271281400Medicaid
FL52062AMedicare ID - Type Unspecified